Wednesday, September 12, 2012
Come and Celebrate Nathan's Life and Legacy
Greetings, friends and family. I just wanted to take a moment to remind everyone that this Saturday at 1pm we will be honoring Nathan by sharing stories, reminiscing over pictures, and loving each other through this difficult time of losing Nathan. Nathan was very dear to many people and our families look forward to getting to know every one of you. We would also like to encourage people to bring their favorite side dish or finger food or dessert or any other food category to the gathering. The only food item we are restricting is pork. We thank you all for taking the time to celebrate our amazing Nathan with us. The address of the event is 878 Filbert Avenue Chico, CA. Take care, loved ones.
Wednesday, September 5, 2012
Nathan's Obituary is online at:
http://www.nbcfh.com/obituaries/index.php?id=567&p=&search=
It will appear in the Chico Enterprise Record and the San Jose Mercury News tomorrow.
http://www.nbcfh.com/obituaries/index.php?id=567&p=&search=
It will appear in the Chico Enterprise Record and the San Jose Mercury News tomorrow.
Hi, We are planning the following events to honor and remember Nathan.
1. A short grave side service will be held at Chico Cemetery on Saturday September 8 at 3PM. Following the service refreshments will be served at Nathan's parents home, 878 Filbert Ave Chico, CA.
2. A celebration of Nathan's Life will be held at Nathan's parents home at 878 Filbert Ave Chico, CA starting at 1 PM on Saturday September 15. Bring your stories, pictures and anything else you wish to share about Nathan. We will provide plenty of food and drink, and tissues.
Looking forward to seeing you!
Rich, Vicki and Melissa
Thursday, August 30, 2012
Hi, Nathan's Dad again. Nathan died at 5:10 AM this morning. He came home to yesterday morning under care of Enloe Hospice. During the last week his lucid periods had become more brief and unpredictable. At one point yesterday when Vicki and were positioning him in the hospital bed Nathan kicked his leg at just the right time to make our efforts successful. I said something about thinking he was not tracking what was going on. Nathan smiled his crooked little smile and gave me that knowing look for the last time. We are all going to miss this guy so much. I will do another post once we sort the funeral arrangements.
Sunday, August 26, 2012
HI this is Rich, Nathan's father doing my first post. Many thanks to Melissa for creating this blog and keeping it up. Melissa is under an incredible load right now with school starting for the kids and herself in addition supporting Nathan, so I am trying to fill in. As you will see, I am a poor substitute in the writing department, but here goes.
When Nathan was discharged from Stanford hospital on July 30 we were offered an apartment on the Stanford Hospital site to allow us to finish Nathan's 2 week radiation treatment. It worked out really well with Nathan and Vicki each with a single bed in the one bedroom and Rich sleeping on the floor in the living room. Nathan did point out that it was very strange to live in such close quarters with his parents again. The clear benefit of the on campus location was being able to make 8am appointments for antibiotic and other treatments with no problem. Nathan was eating pretty well and did not have any significant nausea issues. We managed several outings including a birthday celebration dinner with Nathan's friends from Sacramento and Bay Area, and visits from aunts and uncles on both sides of the family. Melissa and the kids came back for a visit August 5th - 9th. We found a great park for the kids and had a good visit.
Nathan hit one serious setback during this time. His blood levels of the antibiotic vancomycin when up into the danger zone. When this happened several of his labs that had been normal or improving starting moving in a negative direction. His oncologist caught the change and took quick action to stop the vancomycin. Nathan suffered some kidney damage as indicated by his elevated Creatinine levels. This was followed by fluid accumulating in his legs. It is not clear exactly what the cause and effect relationships are in this sequence of events. Nathan's liver labs started heading back in a positive direction in toward the end of the second week of our stay. We headed back to Chico on on August 10th.
The goal of this return to Chico was to get Nathan's bilirubin levels down to 5 mg/dL so that he would have a chance of tolerate the standard chemo regime for cholangiocarcinoma. We had gotten very close to this bilirubin level once while at Stanford on July 28, just after we started radiation, but before the vancomycin issue. We left Stanford with a bilirubin level of 8.0 and a down ward trend. We were optimistic that his home environment would allow the downward trend to continue. Some of this confidence came from the progress Nathan made during his last stay at home after the UCSF drains, but before the Stanford drains. In the last week before he was admitted to Stanford his bilirubin level fell from 13.8 to 9.3. and Nathan appeared to gain back some of the weight he had lost and seemed to have a higher energy level.
Unfortunately we did not have the same outcome this time. Nathan started showing considerable fatigue after arriving home. His appetite fell off in-spite of Melissa's best efforts to encourage him to eat and drink. On Friday evening August 17. Nathan started vomiting and Melissa took him to the emergency room. He was admitted to the hospital with dehydration, an elevated white blood cell count, and pneumonia. They provided IV fluids and antibiotics. His white cell count came down quickly, but was replaced with persistent nausea and ascites, the accumulation of fluid in the abdominal cavity. He has had the ascites fluid drained twice, and the plan is to put in a permanent catheter so it can be drained without the pain of a needle insertion each time. Nathan is showing some mental symptoms that are typical of late stage liver cancer. We fist noticed it in the Stanford outpatient period. Nathan would speak and make hand gestures when he slept. Now he is having hallucinations when he is awake. He is still self aware enough to realize that he is seeing things when you point it out, These symptoms are usually caused by high ammonia levels in the blood, but his ammonia levels are in the normal range since he started taking a medication to address this issue. We are not sure what the cause of the mental symptoms. We are beginning to suspect that the cancer is spreading.
We are working with a team at Enloe to plan for care for Nathan at home. The tentative plan is to move Nathan to his parents house some time this week. Thanks to all of you who are praying and thinking positive thoughts for Nathan.
When Nathan was discharged from Stanford hospital on July 30 we were offered an apartment on the Stanford Hospital site to allow us to finish Nathan's 2 week radiation treatment. It worked out really well with Nathan and Vicki each with a single bed in the one bedroom and Rich sleeping on the floor in the living room. Nathan did point out that it was very strange to live in such close quarters with his parents again. The clear benefit of the on campus location was being able to make 8am appointments for antibiotic and other treatments with no problem. Nathan was eating pretty well and did not have any significant nausea issues. We managed several outings including a birthday celebration dinner with Nathan's friends from Sacramento and Bay Area, and visits from aunts and uncles on both sides of the family. Melissa and the kids came back for a visit August 5th - 9th. We found a great park for the kids and had a good visit.
Nathan hit one serious setback during this time. His blood levels of the antibiotic vancomycin when up into the danger zone. When this happened several of his labs that had been normal or improving starting moving in a negative direction. His oncologist caught the change and took quick action to stop the vancomycin. Nathan suffered some kidney damage as indicated by his elevated Creatinine levels. This was followed by fluid accumulating in his legs. It is not clear exactly what the cause and effect relationships are in this sequence of events. Nathan's liver labs started heading back in a positive direction in toward the end of the second week of our stay. We headed back to Chico on on August 10th.
The goal of this return to Chico was to get Nathan's bilirubin levels down to 5 mg/dL so that he would have a chance of tolerate the standard chemo regime for cholangiocarcinoma. We had gotten very close to this bilirubin level once while at Stanford on July 28, just after we started radiation, but before the vancomycin issue. We left Stanford with a bilirubin level of 8.0 and a down ward trend. We were optimistic that his home environment would allow the downward trend to continue. Some of this confidence came from the progress Nathan made during his last stay at home after the UCSF drains, but before the Stanford drains. In the last week before he was admitted to Stanford his bilirubin level fell from 13.8 to 9.3. and Nathan appeared to gain back some of the weight he had lost and seemed to have a higher energy level.
Unfortunately we did not have the same outcome this time. Nathan started showing considerable fatigue after arriving home. His appetite fell off in-spite of Melissa's best efforts to encourage him to eat and drink. On Friday evening August 17. Nathan started vomiting and Melissa took him to the emergency room. He was admitted to the hospital with dehydration, an elevated white blood cell count, and pneumonia. They provided IV fluids and antibiotics. His white cell count came down quickly, but was replaced with persistent nausea and ascites, the accumulation of fluid in the abdominal cavity. He has had the ascites fluid drained twice, and the plan is to put in a permanent catheter so it can be drained without the pain of a needle insertion each time. Nathan is showing some mental symptoms that are typical of late stage liver cancer. We fist noticed it in the Stanford outpatient period. Nathan would speak and make hand gestures when he slept. Now he is having hallucinations when he is awake. He is still self aware enough to realize that he is seeing things when you point it out, These symptoms are usually caused by high ammonia levels in the blood, but his ammonia levels are in the normal range since he started taking a medication to address this issue. We are not sure what the cause of the mental symptoms. We are beginning to suspect that the cancer is spreading.
We are working with a team at Enloe to plan for care for Nathan at home. The tentative plan is to move Nathan to his parents house some time this week. Thanks to all of you who are praying and thinking positive thoughts for Nathan.
Wednesday, August 1, 2012
Great Nate
I have struggled for the last week or so deciding how I would address this post. So much has happened and it's hard to know where the best place is to start. In partial, this is due to the fact that my emotions have mirrored that of the tidal wave schedule. One day I am completely hopeful and the next day I am a mess of trying to cram and hide my disparity and deny the levity of the situation at hand. Today I choose to be hopeful for the future, and tomorrow and the next day I will choose to do the same because Nathan and my kids need me to be strong. I still don't know where to start with this update because there has been so much great progress in the last 10 days or so, that I just want to shout it out all at once. I am so grateful that I have such good news to share with you about Nathan's progress and his improved health. So, I guess as I am with most things, I will just dive right in and get started.
It seems where I last left off with my last in depth update was an explanation of the issues Nathan was battling with nausea, dehydration, pain management and antibiotics and attacking an infection. I had explained that the decision was made to ween him off slowly from the IV medications and fluids slowly so as not to shock his system. Making this decision seemed to be the right approach in handling the constant two steps forward and one and a half steps back. Before, they would try to take him off IV fluids, pain medications and antibiotics and Nathan would become nauseated. With the more gradual approach of slowly introducing oral pain meds and turning down the fluid IV drip and keeping him on IV antibiotics there was a slow, but steady success. Another great move was putting him on a pain patch as a means to manage his pain. Upon Nathan's improvement and the possibility of him getting discharged approached, there was still the issue of how to keep him on the antibiotics. Many antibiotics can be administered orally, but with the specific antibiotics he has to take it is imperative that he receives them from an IV or some other similar way. Ultimately what they decided to do was give him a PICC line (Peripherally Inserted Central Catheter) and he could inject the antibiotics himself once a day and receive infusion treatment once a day at Stanford on an outpatient basis. Another issue that needed to be dealt with was his drainage bags for his Liver. One of the tumors in his liver is right next to the portal vein in the liver and it was starting to cause problems with the bile drainage. Rather than go in and insert ANOTHER bile drain bag, the team of doctors decided the best way to fix it was to start Nathan on localized radiation treatment and hope that the tumor would shrink enough to alleviate the blockage. While the antibiotic infusion and radiation treatments were available up in Chico, we decided the best thing to do would be continue his care with Stanford Hospital to make sure there was continuity with this treatments. Medical care doesn't always go as planned and we felt that in the event something wrong went up here in Chico at Enloe, Nathan's health could be jeopardized. The unfortunate downside of this, of course, is that he would have to stay down in Palo Alto. His parents, the kids and I had spent several days in Napa and traveling back and forth to the hospital, but the kids and I needed to get back to Chico for a few days. Stanford Hospital was able to put Nathan and his parents in temporary housing during his treatments. The great news was that after 18 days, Nathan was finally getting out of the hospital!!! Being in the hospital that long can bring anyone down, and while Nathan remained his usual wonderful person, it still had some negative effect on his morale. Being out of the hospital would also allow him to have meals that were cooked to his specifications and he would be able to eat them while they were still hot. Since his appetite is not that great at this point, any improvements that can be made to his food is important.
While it is very hard to be away from Nathan right now, I take comfort in the fact that he is getting excellent care by the doctors, his parents, and most importantly, God. I also know that I will be reunited with him very soon and will be able to hold him close to me where he belongs. Yesterday, there was a slight scare with one of the tubes from his drainage bags. When he was flushing the tube out with saline, some of the bile came out from around the site around his abdomen. Nathan's parents took him to see the doctor at Interventional Radiology and after putting him under a mild sedative, they discovered it was only a blockage within the tube and they were able to replace it and send him back to the temporary housing. After the last couple of months, the worse can come to mind and I panicked that something very bad was going to happen. We were relieved to find out it was a relatively simple fix and our decision to keep his care continued down there was affirmed. Had we been up here in Chico, who knows what would or could have happened. Another interesting development has been that Nathan has virtually felt no adverse affects from radiation and says he actually LIKES radiation. At this point, it finally feels like things are heading in the right direction. His test numbers are continually improving, as well. Nathan has kept positive, patient, and inspirational beyond what would ever be expected to be normal, but Nathan is not a normal person. Nathan has always been a very stable, sincere, genuine, patient, understanding, positive person and he has continued to display these traits since the very beginning of this awful nightmare. He has always inspired me to be a better person, but I think everyone could learn a lot from this amazing man. I feel honored that he loves me so much.
Next Wednesday will be the last day of his radiation treatment and they will assess at that point if they want to send him home to Chico for a short period before starting chemotherapy and what will be the next step in his treatment. I have great hopes and expectations that him being home with his family, even if for a little bit, will do wonders for his healing. I especially want to spend as much time with him as possible before the kids begin the school year. I, too, will be starting Chico State in the Fall as a junior. I have struggled with the decision as to whether or not I should continue my education right now in light of the current situation, but I must try my hardest to succeed. It's going to be harder than it was before, but I have an amazing family and partner who support my decision to complete my degree. I also felt that by not going, it would be sending a negative message to my kids. The message I think I would be sending would be: "If something seems to hard to do, don't even try to do it". I need to try for my kids, Nathan and myself. We know there will be many challenges in the future with school, Nathan's illness, comforting the kids and with our finances, but we will battle them as a team.
I want to continue to thank everyone who is praying, hoping, supporting and helping us. I am sorry that I have not been able to thank every one of you individually as I would like to, but please know that your generosity and support do not go unnoticed. Thank you so much and bless you all.
It seems where I last left off with my last in depth update was an explanation of the issues Nathan was battling with nausea, dehydration, pain management and antibiotics and attacking an infection. I had explained that the decision was made to ween him off slowly from the IV medications and fluids slowly so as not to shock his system. Making this decision seemed to be the right approach in handling the constant two steps forward and one and a half steps back. Before, they would try to take him off IV fluids, pain medications and antibiotics and Nathan would become nauseated. With the more gradual approach of slowly introducing oral pain meds and turning down the fluid IV drip and keeping him on IV antibiotics there was a slow, but steady success. Another great move was putting him on a pain patch as a means to manage his pain. Upon Nathan's improvement and the possibility of him getting discharged approached, there was still the issue of how to keep him on the antibiotics. Many antibiotics can be administered orally, but with the specific antibiotics he has to take it is imperative that he receives them from an IV or some other similar way. Ultimately what they decided to do was give him a PICC line (Peripherally Inserted Central Catheter) and he could inject the antibiotics himself once a day and receive infusion treatment once a day at Stanford on an outpatient basis. Another issue that needed to be dealt with was his drainage bags for his Liver. One of the tumors in his liver is right next to the portal vein in the liver and it was starting to cause problems with the bile drainage. Rather than go in and insert ANOTHER bile drain bag, the team of doctors decided the best way to fix it was to start Nathan on localized radiation treatment and hope that the tumor would shrink enough to alleviate the blockage. While the antibiotic infusion and radiation treatments were available up in Chico, we decided the best thing to do would be continue his care with Stanford Hospital to make sure there was continuity with this treatments. Medical care doesn't always go as planned and we felt that in the event something wrong went up here in Chico at Enloe, Nathan's health could be jeopardized. The unfortunate downside of this, of course, is that he would have to stay down in Palo Alto. His parents, the kids and I had spent several days in Napa and traveling back and forth to the hospital, but the kids and I needed to get back to Chico for a few days. Stanford Hospital was able to put Nathan and his parents in temporary housing during his treatments. The great news was that after 18 days, Nathan was finally getting out of the hospital!!! Being in the hospital that long can bring anyone down, and while Nathan remained his usual wonderful person, it still had some negative effect on his morale. Being out of the hospital would also allow him to have meals that were cooked to his specifications and he would be able to eat them while they were still hot. Since his appetite is not that great at this point, any improvements that can be made to his food is important.
While it is very hard to be away from Nathan right now, I take comfort in the fact that he is getting excellent care by the doctors, his parents, and most importantly, God. I also know that I will be reunited with him very soon and will be able to hold him close to me where he belongs. Yesterday, there was a slight scare with one of the tubes from his drainage bags. When he was flushing the tube out with saline, some of the bile came out from around the site around his abdomen. Nathan's parents took him to see the doctor at Interventional Radiology and after putting him under a mild sedative, they discovered it was only a blockage within the tube and they were able to replace it and send him back to the temporary housing. After the last couple of months, the worse can come to mind and I panicked that something very bad was going to happen. We were relieved to find out it was a relatively simple fix and our decision to keep his care continued down there was affirmed. Had we been up here in Chico, who knows what would or could have happened. Another interesting development has been that Nathan has virtually felt no adverse affects from radiation and says he actually LIKES radiation. At this point, it finally feels like things are heading in the right direction. His test numbers are continually improving, as well. Nathan has kept positive, patient, and inspirational beyond what would ever be expected to be normal, but Nathan is not a normal person. Nathan has always been a very stable, sincere, genuine, patient, understanding, positive person and he has continued to display these traits since the very beginning of this awful nightmare. He has always inspired me to be a better person, but I think everyone could learn a lot from this amazing man. I feel honored that he loves me so much.
Next Wednesday will be the last day of his radiation treatment and they will assess at that point if they want to send him home to Chico for a short period before starting chemotherapy and what will be the next step in his treatment. I have great hopes and expectations that him being home with his family, even if for a little bit, will do wonders for his healing. I especially want to spend as much time with him as possible before the kids begin the school year. I, too, will be starting Chico State in the Fall as a junior. I have struggled with the decision as to whether or not I should continue my education right now in light of the current situation, but I must try my hardest to succeed. It's going to be harder than it was before, but I have an amazing family and partner who support my decision to complete my degree. I also felt that by not going, it would be sending a negative message to my kids. The message I think I would be sending would be: "If something seems to hard to do, don't even try to do it". I need to try for my kids, Nathan and myself. We know there will be many challenges in the future with school, Nathan's illness, comforting the kids and with our finances, but we will battle them as a team.
I want to continue to thank everyone who is praying, hoping, supporting and helping us. I am sorry that I have not been able to thank every one of you individually as I would like to, but please know that your generosity and support do not go unnoticed. Thank you so much and bless you all.
Sunday, July 29, 2012
More To Follow...
I apologize for not posting an update recently. Everything has been a little chaotic lately, but I will be returning home very soon and I will make sure to post an update. I will let you know this, however, Nathan's health is improving incrementally and was released from Stanford yesterday, but will be staying in that area for at least a couple weeks to receive radiation treatment. Thank you for everyone's concern, prayers and hope for us; your support does not go unnoticed.
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